Insurance Coverage for Massage

Worse than individuals not having any alternative care coverage at all (which I talk about, in depth, here), is the fact that, on the majority of plans with CAM coverage, massage is specifically excluded.

I don’t understand why more massage therapists aren’t flipping out about this. I suppose it’s because many of them don’t take insurance. Or if they do, perhaps it’s through a chiropractic office (and if a chiropractor is billing for massage services, it’s ok).

Wait, what? It’s true: If a chiropractor is billing for services that include “muscle manipulation” (i.e., massage), insurance will often cover that. Sometimes the person doing this muscle manipulation is a massage therapist working under the chiropractor. Other times it’s the chiropractor him- or herself doing the work.

This is a section of an actual insurance policy. Chiropractors (and their employees) who do massage are covered, but there’s no general coverage for LMTs. When I called the company to clarify, I was told that if a massage therapist billed out for massage, it would be denied.

Are insurance companies really saying that chiropractors are more qualified to do my job than I am? Or that, just because I’m a business owner, my services are less valid?

This is how I imagine the decision went:

Insurance Executive 1: Alternative medicine is all the rage nowadays. Everyone I know has a chiropractor or acupuncturist. We need to figure out a way to make money from this.

Insurance Executive 2: That’s easy – we should offer an expensive “alternative care” rider that people can add to their regular plans. But what should we cover?

IE 1: Well, we should cover naturopathic medicine, because the people who do that are doctors. And chiropractors – I think those people are technically doctors too. And acupuncture… well, I don’t actually know what acupuncture does, but I bet if we didn’t include it people would complain.

IE 2: Ok, sounds good. What about massage?

IE 1: Nahh. My wife goes to a spa every week to get massages. She loves them, but I doubt they actually do anything.

IE 2: Fair point. On the other hand, I went to a chiropractor for a while after I injured my back, and he had a massage therapist there. I always got a massage before my adjustment, and it definitely helped. I’d want all of that to be covered.

IE 1: Well, I’m too lazy to look up any research on the benefits of massage, so let’s just come up with a meaningless distinction between a useful massage and a [insert your choice of demeaning slang here*] massage.

A little exaggerated, but not far from the truth, I’d say. The idea that something can be medically necessary and feel good is still a hard concept to grasp. Preventative care doesn’t fit in the medical framework of “fixing problems”. But if a massage is coupled with chiropractic services, I guess it’s easier to consider it a medical need.

I had an insurance company tell me once that massage was only covered when it was done in conjunction with physical therapy. What study were they reading when they came up with that rule?

As I’ve explained before, this really shouldn’t be the issue. Spas aren’t going to start billing insurance. Anyone who feels that the work they do isn’t medically beneficial (whether it actually is or not) won’t be billing insurance either because, let’s face it – that’s just a bunch of bothersome paperwork.

Sometimes I bill the insurance companies anyway, especially when they use language like in the examples above. And sometimes I even get (partly) reimbursed (excluding copays and coinsurance). Even though I’m not a chiropractor. Even though I don’t work with a physical therapist. Because, at the end of the day, not even insurance companies can properly apply their own confusing and contradictory rules.

But many times I can’t bill the insurance companies when they give me these horrible answers, because it scares my clients away. I have to tell a new client that, if he wanted to come in, he would have to pay out-of-pocket. If I got reimbursed later, I’d be able to return what he originally paid me (minus the copay or coinsurance). But some clients can’t take that risk. I might be 90% sure that I’ll get reimbursed, but they might not have $75 laying around to put towards a massage even temporarily – which is one of the reasons they’re paying for fancy riders and add-ons for their insurance policies in the first place.

The client who has the policy shown above, who (allegedly) only has massage-by-a-chiropractor coverage, cancelled his appointment at the last minute because he wanted to be certain of what his insurance would cover. He didn’t want to pay out in cash when he originally thought he wouldn’t have to, and I understand that. I told him that if he ever got a straight answer from the insurance company, he should contact me again. That seems unlikely.

I guess my main point is that, yes, insurance reform is a great goal, but only for the short term. More people should be covered; more services should be covered. But insurance companies will never have our best interests at heart. What we really need is a system reform.

*my word of choice was “froofy”.

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